Provider Demographics
NPI:1508977109
Name:GLEN P MOREHEAD MD PC
Entity Type:Organization
Organization Name:GLEN P MOREHEAD MD PC
Other - Org Name:SPALDING ONCOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOREHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-229-6007
Mailing Address - Street 1:230D W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4121
Mailing Address - Country:US
Mailing Address - Phone:770-229-6007
Mailing Address - Fax:770-229-1518
Practice Address - Street 1:230D W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4121
Practice Address - Country:US
Practice Address - Phone:770-229-6007
Practice Address - Fax:770-229-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31076207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty